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Orbital Conference: Orbital Inflammation

Home / Orbit, Eyelids, and Lacrimal System / Orbital Inflammatory and Infectious Disorders

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Title: Orbital Conference: Orbital Inflammation

Authors: Christopher D. Conrady, MD, PhD, Rene Choi, MD, PhD, H. Christian Davidson, MD, and BCK Patel, MD

Date: 06/27/16

Keywords/Main Subjects: orbital cellulitis, infection, inflammation, orbit

Diagnosis/Differential Diagnosis: 2 cases of orbital cellulitis

Brief Description of Case: In the following cases, we present two cases of orbital cellulitis, clinical course, and medical/surgical management.  Both patients presented with eyelid swelling.  The first patient also had motility deficits upon presentation.  They were both found to subsequently have orbital inflammatory events with improvement on IV antibiotics.

Images:

Slide 4: External photograph of patient case 1.

Slide 6-7: CT orbits

Slides 8-12: MRI orbits

Slide 13:  CT orbits

Slide 15-18: Pathology slides showing mild, chronic inflammatory cell reaction.

Slide 19: External photograph of patient

Slide 25-26: External photograph of case 2.

Slide 28-32: CT maxillofacial with contrast

Slide 36-40: Pathology of case 2.

Summary of Cases:

These two cases highlight the medical and surgical management of orbital cellulitis.

References for further reading:

• Ebright et al., “Septic Thrombosis of the Cavernous Sinus.” Arch Intern Med, 2001.
• Garcia et al., “Criteria for Nonsurgical Management of Subperiosteal Abscess of the Orbit.” Ophth, 2000
• Harris GJ. Subperiosteal abscess of the orbit. Age as a factor in the bacteriology and response to treatment. Ophthalmology 1994; 101:585-595.
• Harris GJ. Subperiosteal abscess of the orbit: computed tomography and the clinical course. Ophthal Plast Reconstr Surg 1996; 12:1-8.Oxford LE, McClay J. Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children. Int J Pediatr Otorhinolaryngol 2006; 70:1853-1861.
• Harris, “Subperiosteal Abscess of the Orbit: Age as a Factor in the Bacteriology and Response to Treatment”. Ophth, 2014.
• McKinley et al., “Microbiology of Pediatric Orbital Cellulitis.” AJO, 2007.
• Miranda et al., “Brain abscess: Current management. Neuro Rural Prc, 2013.
• Oxford LE, McClay J. Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children. Int J Pediatr Otorhinolaryngol 2006; 70:1853-1861.
• Segal et al., “Orbital Complications associated with paranasal sinus infections – A 10-year experience in Israel.” Int J Ped Otorhino, 2016.
• Seltz et al., Microbiology and Antibiotic Management of Orbital Cellulitis. Peds, 2011.

Copyright statement: Christopher D. Conrady, ©2016. For further information regarding the rights to this collection, please visit: URL to copyright information page on Moran CORE

**Signed off on by orbital conference faculty attendees

Case of Superior Ophthalmic Vein Occlusion

Home / Neuro-Ophthalmology / Efferent Disorders

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Title: Case of Superior Ophthalmic Vein Occlusion
Author: Christopher D. Conrady, MD, PhD, Dr. Zach Joos, MD, Dr. H. Christian Davidson, MD
Date: 09/26/2016
Keywords/Main Subjects: Superior ophthalmic vein occlusion; Septic cavernous sinus thrombosis
Diagnosis: Left SOVT with concurrent septic cavernous sinus thrombosis
Brief Description: In the following case, we present a 72-year-old lady that presented to her outside physician for cough, congestion, and headaches.  She was started on Flonase for presumed allergic rhinitis but the headaches continue to worsen.  She stopped the Flonase only to develop a complete ophthalmoplegia and ptosis of the left eye with mild proptosis.  She was then sent to her local ED by her PCP for further evaluation and eventually transferred to the University of Utah for treatment.  She was found to have a left SOVT with some involvement of the cavernous sinus.  She underwent sinus surgery, dental extraction, and was started on broad-spectrum antibiotics and anticoagulation.  She has since made a nearly complete recovery.

Images:

Slide 16: External photograph of the patient.  Patient was found to have mild proptosis, ptosis, and severe conjunctivochalasis of the left eye.

Slides 10-14: CT angiogram noting left superior ophthalmic vein occlusion and septic cavernous sinus thrombosis.

Slide 15:  MRA brain without contrast: Flow void of left superior ophthalmic vein consistent with thrombosis.

Slide 16: Coronal MRI brain without contrast with asymmetry of left portion of the cavernous sinus suggesting a septic cavernous sinus thrombosis.

Summary of Case:

1. Superior ophthalmic vein occlusion needs to be considered in any orbital cellulitis picture as the clinical presentations can closely resemble one another.

1. Imaging can help guide the diagnosis.
2. While still somewhat controversial despite a small, randomized control trial, the AAO currently recommends dose-adjusted IV heparin for and an extended course of intravenous, broad-spectrum antibiotics for a SOVT from an infectious etiology.

Format: PDF
Series: Orbit Conference
References:

Desa V, Green R. J Oral Maxillofac Surg. 2012;70(9):2085-2091.

Einhaupl A et al. Lancet. 1991;338(8767):597-600.

Michaelides et al., J. Ophth Scand, 2003.  81:88-90.

Mishima, et al., J Med Case Rep. 2015; 9:244.

Sambhav et al., Int Med Case Rep. 2015; 8:181-183.

Schmitt NJ et al. Ophthal Plast Reconstr Surg. 2005;21(5):387-389

Smith et al., J. Clin NeuroOphtho. 1983. 3: 83.

Syed et al., Proc Univ Med Cent; 2016; 29(1):36-38.
Faculty Approval: Signed off on by orbital conference faculty attendees
Identifier: Moran_CORE_22006
Copyright statement: Christopher D. Conrady, ©2016.. Please see terms of use page for more information.